"Trigger Points"
Trigger points are very real entities that have a definite physiological manifestation. They are often but not exclusively palpable as tiny nodules in and near muscle, in areas of muscle tightness ("taut bands"). They are also detectable with electrical devices ranging from electrodes placed on the skin, to needle electromyography. But they are difficult or impossible to detect in biopsy.
Trigger points are often associated with muscular pain in adjacent, and sometimes remote, areas. Resolving the trigger point will often alleviate the associated pain. This is usually done either through direct pressure on the trigger point, or mechanically by contacting the trigger point with a fine needle, or through electrical stimulation or pharmacological means such as direct injection of local anesthetics. Thus the discovery and resolution of trigger points is often a goal of therapy for muscular-skeletal pain.
There are other kinds of "points" as well. For example, there are "tender points", "acupressure points" and "acupuncture points" from traditional Chinese medicine, and "polarity points". These are distinct from "trigger points".
The underlying physiology of trigger points is not necessarily fully understood. The best explanation may be that trigger points are caused by intrafusal contractions (localized muscle contractions) caused by a sympathetic nervous system. The physiological function that trigger points serve has not been positively determined.
In summary, trigger points are small (a few millimeters or less) nodules within a tight band of muscle that are tender to the touch and cause a characteristic pattern of pain, tingling, or numbness when subjected to sustained pressure. They have also been documented in skin, ligament, tendon, scar and breast tissue and periostenen. The trigger point is often associated with referred pain, usually locally (in the same muscle), but sometimes surprisingly remote. Inactivation of the trigger point reduces or resolves the associated pain.
Discovery and Resolution through Electrical Stimulation
Resolving the trigger point will often alleviate the associated pain. This may be done through myofascial electrical stimulation of the trigger point. An electrical wand or probe (an electrode) is moved over the skin in the suspect area for the trigger point. When the precise area for the trigger point is discovered, a ripple effect or a tingling sensation may be felt in the associated muscle which when continued for a while alleviates the associated pain and resolves the trigger point in a few, if not one, treatment(s) of several minutes each. The electrical stimulation relaxes muscle spasms and increases localized circulation to fix the source of the trigger point.
The wand, more or less in the shape of a pencil or flashlight, is formed at one end with a thin, flat, spatula-like or rectangular, flat blade extension, the outer edge of which is run over a patient's skin to discover the trigger point causing the pain. Sometimes an outer corner of the extension is utilized to locate more precisely the trigger point and apply even more localized electrical stimulation. Efforts to improve the electrical connection between the extension and the patient's skin have included coating the extension with a conductive gel.
Machine for Source of Electrical Stimulation
A machine for the source of electrical stimulation of trigger points, is manufactured by the Rich-Mar Corporation; Rt. 2, Box 879; Inola, Okla. 74036-0879; as Model HV 2000, a high voltage pulsed Current (HVPC) device. It provides a suitable pulsed high voltage at an appropriate frequency and micro-amperage to the probe or wand. The wand, more or less in the shape of a pencil or flashlight, is used by therapists to locate precisely and treat the trigger points . This works fine in the hands of a therapist, but a pencil- or flashlight shaped wand is ill suited for an individual to move across his back to locate precisely therein a trigger point and to thereafter hold the wand in place and continuously apply electrical stimulation to the trigger point.